Indiana - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Indiana Family and Social Services Administration (FSSA) Division of Disability and Rehabilitative Services (DDRS) approves providers to deliver home and community-based services through the Community Integration and Habilitation (CIH) and Family Supports (FSW) waivers. Prospective agencies must first pass the Bureau of Disabilities Services (BDS) New Provider Approval process, which requires proof of financial solvency, submission of specific policies under 460 IAC 6, and a mandatory in-person BDS Leadership Training Series at the Indiana Government Center before final Medicaid enrollment is granted.

Once BDS grants pending provisional approval, the entity applies through the Indiana Health Coverage Programs (IHCP) Provider Healthcare Portal to receive a Medicaid provider number. Applicants whose leadership team includes any individual previously terminated as an HCBS waiver provider in Indiana are structurally barred from approval, and agencies failing to respond to a Request for Information (RFI) within 30 days face a mandatory two-year lockout before they can reapply.

1. Service Definition and Scope

Indiana's I/DD waiver services are funded through the CIH and FSW waivers, covering a spectrum from intermittent family supports to 24/7 residential habilitation. Services are defined in the approved 1915(c) waiver appendices and governed by 460 IAC 6.

The service array encompasses community-based habilitation, structured family caregiving, respite, and supported living, with specific provider qualifications tied to each service tier.

• Waiver Authority: Community Integration and Habilitation (CIH) and Family Supports Waiver (FSW) under Section 1915(c)
• Residential Habilitation: Provider-managed supported living services delivered in the participant's home or a provider-controlled setting
• Community-Based Habilitation: Services provided outside the home supporting learning, self-care, and socialization
• Structured Family Caregiving: Support provided by a principal caregiver who lives with the participant, approved by BDS
• Respite Care: Short-term relief for primary caregivers, requiring FSSA/DDRS approval as a Respite Agency or Licensed Home Health Agency

2. Regulatory and Oversight Agencies

The FSSA divides oversight between programmatic approval and Medicaid financial enrollment. DDRS and its sub-bureaus handle provider certification and quality, while OMPP manages the Medicaid state plan and IHCP enrollment.

Post-enrollment compliance and incident management are monitored by the Bureau of Quality Improvement Services (BQIS).

• Indiana Family and Social Services Administration (FSSA): https://www.in.gov/fssa/
• Division of Disability and Rehabilitative Services (DDRS): https://www.in.gov/fssa/ddrs/
• Bureau of Disabilities Services (BDS): https://www.in.gov/fssa/ddrs/developmental-disability-services/
• Bureau of Quality Improvement Services (BQIS): https://www.in.gov/fssa/ddrs/quality-improvement-services/
• Office of Medicaid Policy and Planning (OMPP): https://www.in.gov/fssa/ompp/

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana utilizes a closed-loop initial approval process managed by BDS. An applicant cannot simply enroll in Medicaid; they must first submit a BDS New Provider Application and receive pending provisional approval.

Certain structural barriers immediately disqualify applicants, including leadership history and failure to meet strict administrative deadlines during the application phase.

• BDS New Provider Application: Mandatory initial submission to DDRS before any Medicaid enrollment is permitted
• Executive Leadership Ban: Applicants cannot include any leadership team member (CEO, COO, CFO) who served in an executive capacity for a terminated Indiana HCBS waiver provider
• Financial Solvency Requirement: Applicants must submit proof of cash reserves and capital as part of the BDS application
• Two-Year Lockout: If an application is denied for failing to answer an RFI within 30 days, the applicant must wait a minimum of two years before submitting a new application
• Mandatory Leadership Training: Agency leadership must attend the in-person BDS Leadership Training Series at the Indiana Government Center within one year of the pending provisional approval letter

4. Licensure and Certification Requirements

Indiana does not issue a traditional facility license for HCBS waiver providers, except for Group Homes (ICF/IID) which are licensed by the Indiana Department of Health under 460 IAC 9. Instead, waiver providers receive certification from BDS under 460 IAC 6.

Applicants must demonstrate readiness by submitting comprehensive policies, professional references, and proof of educational background supporting their qualifications.

• Governing Rule: 460 IAC 6 establishes the standards for Supported Living Services and Supports
• Provisional Approval: Initial certification granted by BDS, allowing the provider to proceed to IHCP enrollment
• Policy Submission: Applicants must submit specific policies and procedures required for the types of services to be provided during the BDS application
• Professional References: Two professional references are required, with one directly related to experience in the I/DD community
• Group Home Exception: Supervised Group Living (SGL) requires licensure by the Indiana Department of Health under 460 IAC 9, though BDS is currently not approving the addition of new SGL homes

5. Medicaid Provider Enrollment

After obtaining BDS provisional approval, providers must enroll in the Indiana Health Coverage Programs (IHCP). This is done via the IHCP Provider Healthcare Portal or by submitting the IHCP Waiver Group Provider Enrollment Packet.

The state enforces strict physical location requirements and conducts site visits for providers deemed moderate or high risk.

• IHCP Provider Healthcare Portal: https://portal.indianamedicaid.com/
• Enrollment Packet: IHCP Waiver Group Provider Enrollment and Maintenance Form
• Service Location: Must be a physical address where supporting documentation is kept; PO Boxes are not permitted
• Site Visits: Providers classified as moderate or high risk require pre- and post-enrollment site visits pursuant to 42 CFR 455.432 and IC 12-15-1-22
• Application Fee: Required for certain provider types upon initial enrollment, revalidation, or adding a service location, unless exempted by Medicare enrollment

6. Staffing, Training and Background Checks

Direct support professionals and agency leadership must meet qualifications outlined in 460 IAC 6. Background checks are strictly enforced through the Indiana Central Repository.

Agencies must ensure all staff pass required checks before delivering direct supports, with specific rules for out-of-county residency.

• Criminal History Check: Required per 460 IAC 6-10-5 through the Indiana Central Repository
• Out-of-County Checks: Providers must conduct checks for each county the employee resided in during the three years prior to hire
• Behavior Management Qualifications: Level 2 behavior management candidates must meet educational and experience requirements set forth in 460 IAC 6-5-4
• Tuberculosis (TB) Testing: Required for all direct support staff prior to delivering services
• Leadership Training: CEO, COO, Waiver Administrator, and Systems Designee must complete the BDS Leadership Training Series

7. Documentation, Policies and Records

Providers must maintain comprehensive records at their designated IHCP service location. BQIS conducts case record reviews and investigates complaints to ensure compliance with 460 IAC 6.

Corporate documentation must perfectly match IRS records, and any DBA must be formally registered with the state or county.

• Claim Documentation: Must be kept at the physical service location registered with IHCP
• W-9 and DBA Registration: Providers using a Doing Business As (DBA) name must attach Secretary of State or county recorder registration matching the W-9
• Educational Background Records: Agencies must maintain documentation supporting the qualifications of all HCBS staff
• Incident Reporting: Providers must adhere to DDRS incident reporting policies for any adverse events involving waiver participants

8. Billing, Rates and Claims

Claims for CIH and FSW waiver services are submitted to the IHCP CoreMMIS system. Rates are established by FSSA and published in the IHCP provider bulletins and fee schedules.

Services must be prior-authorized and built into the member's waiver budget before claims will pay.

• Billing System: IHCP CoreMMIS accessed via the Provider Healthcare Portal
• Waiver Budgeting: The eligibility system builds a waiver budget for members; claims exceeding the authorized Notice of Action (NOA) budget will deny
• Rate Methodology: Established by OMPP and DDRS, with specific billing codes and modifiers detailed in the HCBS Waivers Provider Reference Module
• Transitional Billing: Money Follows the Person (MFP) provides transitional services for 365 days before transitioning to standard waiver billing

9. Approval Sequence and Timeline

The end-to-end process requires sequential approvals from BDS and IHCP. Missing a deadline, such as the RFI response window, terminates the process immediately.

Final approval is only granted after Medicaid enrollment is confirmed and the DDRS Service Provider Agreement is signed.

• Step 1: Submit BDS New Provider Application with financial proof and policies
• Step 2: Respond to any BDS Request for Information (RFI) within 30 calendar days
• Step 3: Receive Pending Provisional Approval letter from BDS
• Step 4: Submit IHCP Waiver Group Provider Enrollment Packet to Medicaid
• Step 5: Attend BDS Leadership Training Series within one year of provisional approval
• Step 6: Sign DDRS Service Provider Agreement upon final Medicaid enrollment confirmation

10. Common Denials and Survey Findings

Applications are frequently denied for administrative omissions or failing structural gates. Post-enrollment, BQIS cites providers for documentation and background check failures.

Strict adherence to physical location rules and leadership background requirements is necessary to avoid rejection.

• RFI Timeout: Automatic denial and two-year lockout for failing to return the RFI within 30 days
• Leadership Ban Violation: Denial for including a former executive of a terminated HCBS agency on the leadership team
• Invalid Service Location: Rejection of IHCP enrollment for using a PO Box instead of a physical address where records are kept
• Background Check Delays: BQIS citations for allowing staff to provide direct supports before the Indiana Central Repository check is complete

11. Key Contacts and Resources

Primary interactions occur through the BDS Provider Services team and the IHCP Provider Relations consultants.

Providers should regularly monitor IHCP bulletins for rate changes and DDRS announcements for policy updates.

• BDS Provider Services: https://www.in.gov/fssa/ddrs/developmental-disability-services/
• IHCP Provider Healthcare Portal: https://portal.indianamedicaid.com/
• Indiana Medicaid Provider Relations: 1-800-577-1278 (Provider Customer Assistance)
• Indiana General Assembly (Administrative Code): https://iga.in.gov/

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